he contribution of physicians to the making of nationa - PDF document

ern diplomacy and foreign policy as the deci- AIDS as a Paradigm Example ofthe New Requirements end of the Cold War and advances in com-trade, regional integration, and the substan-roads and canals, railroad networks travers- 234 Medicine & Global Survival 1994; Vol. 1, No. 4The Diplomat/Physician The Diplomat/PhysicianIn the Emerging International System Louis M. Marmon, MD, PhD, Christopher M. Seniw, BA, and Allan E.Goodman, MPA, PhD ꤀Copyright 1994 Medicine and Global Survival century, AIDS has surmounted all politicaland geographic boundaries. Yet, the searchfor methods to control AIDS and to discoverits source has exacerbated already strainedrelations among certain countries. Efforts byWestern researchers to ascribe the origin ofHIVHIVAfrica have been denounced, for example, assome political leaders argue that researchfindings perpetuate racially motivatedstereotypes. Regional and ethnic group rela--While AIDS is still a smaller cause ofdeath in terms of actual numbers when com-pared to other diseases such as cancer orheart disease, the specter of a global and per-haps incurable epidemic may soon requiregovernments to rethink immigration andother national policies affecting the freedomto travel, the right to privacy, and the need toprotect society from exposure to a deadly dis-ease. For centuries, the reflex response toplague and pestilence has been to barstrangers from the city gates. Although todayblood tests for antibodies to HIV couldreplace the obstacles of the past, the HIV-infected traveler can still travel freely tomany areas. One of the authors, for example,has recently travelled throughout East andSouth East Asia where even communist andsocialist governments with highly restrictiveand cumbersome immigration policies andprocedures manifest little interest in deter-mining who might be entering the countryHIV-positive. Although still not an issue ofsecurity in the classic sense in which this termis used in international relations, moreover,AIDS will soon force many countries to con--Determining the right policies to deal withthe social and regional impact of AIDS insuch circumstances will demand a blend ofmedical and political judgments that, giventheir present training, neither doctors nordiplomats can effectively make.The economic implications of AIDS alsotake the diplomat/physician into unchartedterritory. In the "developed" world AIDSpatients are a major source of health careexpenditures and these costs are only project-ed to get worse. In many developing coun-tries, the economics of AIDS usually meansthat HIV-positive patients get no treatment atall. In Africa the very existence of the extend-ed family, which tradition ally has been thesafety net for sick or unemployed familymembers, is now threatened as many of themembers who support the extended family,i.e. the 15 to 64-year-old age group, are nowbecoming afflicted with AIDS. Who will sup-port all of the orphaned children (many ofwhom are HIV positive themselves) whentheir mothers die from AIDS? The extendedfamily? The government? International pub-lic health programs? Combined with theseproblems is the impact of loss of tourism thatmay occur as xenophobia and fear of HIVinfection rise. This can only exacerbate eco-nomic difficulties -- and prevent an effectiveresponse to the vectors of the disease -- inthose nations that depend largely on tourismdollars to keep the country afloat. InThailand, where AIDS is rampant, recentsocial science surveys indicate that three-quarters of the urban male population visit aprostitute each week and tourist literaturefeatures "Sex Holidays" as well as tips for for-eigners on how to arrange for "sexual ser-vices." Government health officials have sup-ported only mild warnings for visitors to"take appropriate precautions." Thai prosti--The problems of how best to containworld population growth and deal withexpanding energy consumption are furtherinstances of the intersection of medicine andpublic policy in the international forum. Thedevelopment of programs for birth control,women's health, and family planning areoften at odds with local governmental policyand cultural bias. Economic pressures, envi- The Diplomat/PhysicianMarmon et al 235 As the health problems of the future and theirmyriad ramifications become every country'sdomestic priority, any approach to these con-cerns must be coordinated and executed at aninternational level in order to be effective.The political and medical difficultiesinvolved in responding to the multiplethreats AIDS poses to society can be seen asexamples of common issues that arise inresponding to other pressing internationalhealth concerns, such as revamping thehealth care system in the countries of the for-mer Soviet Union or creating such a system incountries where the international communityhas taken on nation-building responsibilitiessuch as in Somalia. It is evident, from thisperspective, that physicians will be necessaryto an adequate decision-making process inthe development of foreign policy and that tobe truly useful they will need to be as welleducated as diplomats about the business,cultural, economic, political, and bureaucrat- The Role and Training of the with relief efforts. Having skills in both are-volunteers or on staff with private interna-base in diplomacy, foreign language, interna---ty systems that contain medical schools orwhere links could be established with nearbymedical institutions. The APSIA schools havebeen offering joint degrees in law, business,and social science disciplines for nearly twen-own "joint" degree by taking leave after com- 236 Medicine & Global Survival 1994; Vol. 1, No. 4The Diplomat/Physician nexus between health and international rela-to suggest that a master's degree in interna-already manifest in the emerging internation-finding for themselves, "any further elabora- how they are changing the nature of interna- The Diplomat/PhysicianMarmon et al 237